Review article
UDC: 61:303.064:331.54
Svetozar ZDRAVKOVI∆
Dubravka STRIBER-DEVAJA
Vladimir Vit. BALTI∆
Archive of Oncology 2000;8(4):177-9.
Future of telemedicine: Internet2 ?
ABSTRACT
Internet2 is a consortium being led by over 180 universities working in partnership with industry
and government to develop and deploy advanced network applications and technologies for tomorrow’s Internet. The first basic principle of Internet2 is to ensure that Internet2 maintain an infrastructure flexible enough to work with current requirements, yet to be adaptable for future nowunknown needs and to provide a highway for higher bandwidth traffic using Internet Protocol version 6 (IPv6). The second basic principle of Internet2 is built up in the strategy of affordable communication named ”common bearer service”, which means a model of communicating from one connected node to any other connected node. One of the ways to ensure bandwidth, and keep it affordable for the institutions involved, is to establish what has come to be known as a gigapop (”gigabit
capacity point of presence”). More or less, Internet2 is going to look very similar to the current
Internet-data viewed in a Web browser, but so far, it is strictly being used as a pipeline to transfer
data. According to the University Corporation for Advanced Internet Development, the minimum
period of complete implementation of Internet2 is 24 months. Experience told us that the average
period of establishing Internet as an every day practice is about 3 years (like in Yugoslavia, for
example) which leads us to conclude that approximately 5 years is needed to implement new technology such as Internet2 in middle developed countries. Oncology, as one of the most complex
domains of medicine and because of that a great user of telemedicine, is the most acceptable for the
new technology such as Internet2. There is no doubt, that oncology will find the fastest way to join
the Internet2 user society.
Key words: Internet2; Telemedicine; Computer communication networks; Telecommunication
networks; Oncology
INSTITUTE OF ONCOLOGY SREMSKA KAMENICA, YUGOSLAVIA
INTRODUCTION
There are hardly any people from urban
society who do not know what the Internet is
and what the Internet services (e-mail, www,
ftp,) are. But, the concept of Internet2 is not
widely known by the educated part of population. What is really the concept of Internet2?
Internet2 is a consortium being led by over 180
universities working in partnership with industry and government to develop and deploy
advanced network applications and technologies, accelerating the creation of tomorrow's
Internet. Practically, Internet2 is a collaboration
Address correspondence to:
Svetozar ZdravkoviÊ, Institute of Oncology Sremska
Kamenica, Institutski put 4, 21204 Sremska Kamenica,
Yugoslavia; e-mail: svetozar¤uns.ns.ac.yu
The manuscript was received: 06. 11. 2000.
Provisionally accepted: 22. 11. 2000.
Accepted for publication: 24. 11. 2000.
Ç 2000, Institute of Oncology Sremska Kamenica,Yugoslavia
Archive of Oncology 2000,8(4):177-9Ç2000,Institute of Oncology Sremska Kamenica, Yugoslavia
of over 130 United States universities, teamed
up with industry and government, to develop
advanced Internet technology and applications
for high-end academic experimenting and
research. Colleges and universities will use
Internet2 to explore areas of instruction,
research, and public service, such as learningware (software designed for classroom and distance learning), digital libraries, tele-immersion
(such as telemedicine), and virtual laboratories.
Eventually, the plan is that the technology will
be available to everyone.
According to these facts, the primary goals
of Internet2 are to:
- Create a leading edge network capability
for the national research community
- Enable revolutionary Internet applications
- Ensure the rapid transfer of new network
services and applications to the broader Internet
community.
WHY INTERNET2
Basic characteristics of today’s Internet are:
- Millions of users,
177
- Web, email, low-quality audio & video,
- Interconnect personal computers and
servers,
- Applications adapt to underlying technology.
Graph 1. Number of people using Internet
The trend of number of people using
Internet is presented in Graph 1.
But, today’s needs are more complex:
- Millions and millions of users
- Less congestion
- Multimedia
ZdravkoviÊ S.
- Real time interaction,
which Internet is not designed for. On the
other side, only the Internet can accommodate
explosive growth and enable convergence of
information work, mass media, and human collaboration. These facts caused new concept
called Internet2. Leadership of developing new
concept, Internet2, is in hands of universities
and there are several reasons for that, but the
most important are:
- The Internet came from the academic community
- National Science Foundation’s Network
NSFNet (the scaled-up Internet)
- European Organization for Nuclear
Research CERN (the WWW protocols)
- University of Illinois (the Web browser)
- Stanford University (the Internet protocols)
- Universities’ research and education mission require an advanced Internet and have
demonstrated they can develop it
Naturally, Internet2 corporate partners
must back up the universities. Corporate partners are:
3Com, Advanced Network & Services,
Alcatel, Ameritech, AT&T, Cabletron Systems,
Cisco Systems, IBM, ITC Deltacom, Lucent
Technologies, Marconi, WorldCom, Microsoft,
Newbridge Networks, Netcom Systems, Nortel
Networks, Qwest Communications, SBC
Communications, WCI Cable.
This list of companies guarantees not only
financial success of the concept of Internet2, but
technological support as well.
Summarizing these aspects, Internet2
should not be a production network meant to
conduct commerce and academic business nor
should it be an experimental network reserved
for researchers: Internet2 must accommodate
the needs of a diverse academic community to
learn, teach, conduct business, and support
research in many disciplines.
INTERNET2 BASIC
PRINCIPLES
How does Internet2 work?
The first basic principle of Internet2 is to
ensure that Internet2 maintain an infrastructure
flexible enough to work with current requirements, yet to be adaptable for future nowunknown needs. The Internet2 network design,
which will remain compatible with the current
Internet, will provide a highway for higher
bandwidth traffic. Internet2 uses Internet
Protocol version 6 (IPv6) instead of the current
Internet Protocol (IPv4). IPv6 uses a different
package scheme, the advantage of which is that
it incorporates native multi-casting, high reliability, and high capacity. IPv6 will allow applications requiring high bandwidth to coexist
with each other simultaneously. Because IPv6
users are able to send one content packet to
many locations-instead of the current method of
Ç 2000, Institute of Oncology Sremska Kamenica,Yugoslavia
sending many packets to many locationsand/or send data with guaranteed delivery and
performance. Real-time data can now be utilized
in real time. This means, for example, that a
physician at the Doheny Eye Institute in Los
Angeles can perform a retinal exam on a patient
who is hooked up to a machine in rural San
Joaquin, California. This example can almost be
realized on today’s Internet, but, in the final
analysis, it demands a quality of service that
cannot be extracted from today’s Internet. The
quality of service sometimes may depend solely
on the high-probability availability of raw bandwidth, but it often depends on the availability of
differentiated network services designed, for
example, to insure against problems of latency
in delivering 30-frames-per-second (fps), synchronized video from distant server to personal
computer. Unlike today’s Internet, 30 fps can be
guaranteed over Internet2-no jerkiness, no
delays, and no frames dropping out. As a proof
for this state, a good experience with transmission of live laparoscopic surgery over Internet2
can be used (1). The scheme of Internet2 network architecture is presented in Figure 1.
of high bandwidth data while only bearing the
cost of connecting to their gigapop. The scheme
of Internet2 GigaPoPs is presented in Figure 2.
Figure 2. Internet GigaPops (situation in March
2000 in the USA)
How fast is Internet2?
A standard 10Base T Ethernet card, the kind
that is in most LAN-connected computers,
transfers data at 10 megabits per second.
100Base T Ethernet cards are available to transfer data at 100 megabits per second. Internet2
Ethernet card transfer rates are in the gigabits.
Comparison of the Internet2 Land Speed Record
downloaded ”The Matrix” DVD is presented in
Graph 2.
How can someone get in?
Figure 1. Internet2 network architecture
The second basic principle is built up in the
strategy of affordable communication named
”common bearer service”, which means model
of communicating from one connected node to
any other connected node. One of the ways to
ensure bandwidth, and keep it affordable for the
institutions involved, is to establish what has
come to be known as a gigapop, which stands
for ”gigabit capacity point of presence”.
According to University Corporation for
Advanced Internet Development (UCAID), a
gigapop is a high-capacity, state-of-the-art interconnection point where Internet2 participants
can exchange advanced services traffic with
other Internet2 participants. Campuses in a geographic region will join together to acquire a
variety of Internet services at a regional
gigapop. This is a great advantage, because it
means that instead of each institution having to
build their own high bandwidth networks
between each other, they can build a connection
just to the gigapop, which is already connected
to other member institutions. Also, the consortium that manages Internet2 will be responsible
for building, maintaining, and, if necessary, fixing the connections between gigapops. By using
this method, nothing really changes for the end
user, and the institution can guarantee delivery
178
Graph 2. Comparison of the Internet2 Land
Speed Record downloaded ”The Matrix” DVD
At this point, the one who want to get in,
must be a member in order to use Internet2,
which means to be a part of a university, a nonprofit organization involved in networking, or a
corporation interested in developing Internet2.
Of course, he has to be able to bear the financial
investment required to provide onsite facilities.
(2-23)
When Internet2 is going to be available to
the rest of us?
UCAID predicts that the number of
Internet2 academic members will grow significantly during the next six months. Over the following 12 months, it is expected that most
Internet2 members to upgrade at least their
campus backbones, most gigapops to become
operational, and connections among Internet2
members and gigapops to be working. Within
about 24 months of project inception, they
expect teachers and researchers on Internet2
Internet2
campuses to have routine access to Internet2
network service for their network-based applications.
The commercial transition will happen very
quickly because companies like AT&T, Sprint,
and MCI have been watching the progress closely, and can create their own backbone based on
the UCAID model. They are likely to use the
gigapop approach and sell similar services to
downstream providers. And, because Internet2
is designed to take advantage of existing ”offthe-shelf” technology, switch and router makers, like Cisco Systems, will continue to push the
capabilities of their products and make them
available to the private sector.
It is hoped that this will then invite competition into the network market to keep the costs
down and quality of service high.
Similarly to the current Internet, money is
the great motivator needed to push the Internet2
envelope. Even in an academic environment,
institutions have to pony up serious capital (or
win significant grants) before they can really test
Internet2‘s capabilities. Once commercial companies create their own backbones and start
offering service to the public, things are going to
get interesting. Just like the current Internet, it is
the individual developers working on their
home computers who will figure out ways to
push the medium.
What does Internet2 look like, or what is it
going to look like?
Chances are, Internet2 is going to look very
similar to the current Internet-at first. Data will
be viewed in a Web browser, just like it is now.
At this point, development on Internet2 is in its
infancy. So far, it is strictly being used as a
pipeline to transfer data. It is expected that
Internet2 developers are planning to upgrade
outdated technology like email. Things like
improved Web searching and guaranteed email
delivery and tracing must be part of the
Internet2 design core.
Eventually, the line between television and
the Internet will become blurred. It is likely that
all media will be delivered over Internet2. For
the end user, that means seamless access to
unlimited information and/or your favorite TV
show. Users will not be able to tell that the content they are viewing is coming across the
Internet2 backbone instead of the Internet network.
Oncology, Telemedicine and Internet2how close are they connected?
One of Internet2 focus areas is advanced
application such as:
- Distributed computation
- Virtual laboratories
- Digital libraries
- Distributed learning
- Digital video
- Tele-immersion
- All of the above in combination
Ç 2000, Institute of Oncology Sremska Kamenica,Yugoslavia
Most of these items can be found in application aspects of telemedicine. Because of that,
development of these focus areas of Internet2 is
automatically development of telemedicine
itself. This fact will help to answer the question
asked in this title, by giving the several examples. The most interesting application aspects
for medicine, better to say, for telemedicine, are
real-time accesses to remote instruments (basic
for telesurgery for example). There are many
projects with these titles such as at University of
Pittsburgh, Pittsburgh Supercomputing Center,
called 3-D Brain Mapping, at University of
North Carolina, Chapel Hill, called Distributed
nanoManipulator and at University of Illinois,
Chicago, called Shared virtual reality -Virtual
Temporal Bone.
But the problem with telemedicine is that its
preparation costs very much. The concept of
Internet2 just offers solution for this. The investments by universities in Internet2, coupled with
the efforts of industry and government, are
helping to develop technologies such as IPv6,
multicasting, and Quality-of-Service that will
enable a new generation of Internet applications, benefiting all sectors of the society, especially medicine and oncology as its important
part. The wisdom of this approach to network
research has been proven by the rise of today’s
Internet from the academic and federal research
networks of the 1980s. Internet2 will replicate
this success for the new millennium by relying
on the university community for pre-commercial development. (24-33)
Oncology, as one of the most complex
domains of medicine and because of that, a
great user of telemedicine, is the most acceptable for new technology such as Internet2. There
is no doubt, that oncology will find the fastest
way to join the Internet2 user society.
CONCLUSION
On the other side, the government should
provide good environment for investments in
medicine and technology which is the first step
in building telemedicine. Serbia has engineers
and physicians, knowledge and good will for
implementing new technology in medicine
(oncology), only the better organization and
coordination between experts in medicine and
telecommunication is needed to successfully finish this project.
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However, all other countries, Yugoslavia as
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experience told us that the average period of
establishing Internet as an every-day practice is
about 3 years (like in Yugoslavia, for example)
which leads us to conclude that approximately 5
years are needed to implement new technology
such as Internet2 in middle developed countries.
In the meantime, Yugoslavia and its medicine, specially oncology, has enough time to prepare for this new technology which will finally
bring the telemedicine in every-day practice in a
new, better way.
179
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